Healthcare Provider Details

I. General information

NPI: 1700072352
Provider Name (Legal Business Name): I W CHANG MD PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 COLUMBIA AVE
MUNSTER IN
46321-2905
US

IV. Provider business mailing address

9030 COLUMBIA AVE
MUNSTER IN
46321-2905
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-6002
  • Fax:
Mailing address:
  • Phone: 219-836-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: I. W. CHANG
Title or Position: PRESIDENT
Credential: MD
Phone: 219-836-6002